Blended Learning (BL) is one of the most used methods in education to promote active learning and enhance students' learning outcomes. Although BL has existed for over a decade, there are still several challenges associated with it. For instance, the teachers' and students' individual differences, such as their behaviors and attitudes, might impact their adoption of BL. These challenges are further exacerbated by the COVID-19 pandemic, as schools and universities had to combine both online and offline courses to keep up with health regulations. This study conducts a systematic review of systematic reviews on BL, based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to identify BL trends, gaps and future directions. The obtained findings highlight that BL was mostly investigated in higher education and targeted students in the first place. Additionally, most of the BL research is coming from developed countries, calling for cross-collaborations to facilitate BL adoption in developing countries in particular. Furthermore, a lack of ICT skills and infrastructure are the most encountered challenges by teachers, students and institutions. The findings of this study can create a roadmap to facilitate the adoption of BL. The findings of this study could facilitate the design and adoption of BL which is one of the possible solutions to face major health challenges, such as the COVID-19 pandemic.

/pdf/a-systematic-review-of-systematic-reviews-on-blended-49mzk9x0at.pdf

A Systematic Review of Systematic Reviews on Blended Learning: Trends, Gaps and Future Directions.

Rheumatoid arthritis (RA) is a progressive inflammatory disorder characterized by swollen joints, discomfort, tightness, bone degeneration and frailty. Genetic, agamogenetic and sex-specific variables, Prevotella, diet, oral health and gut microbiota imbalance are all likely causes of the onset or development of RA, perhaps the specific pathways remain unknown. Lactobacillus spp. probiotics are often utilized as relief or dietary supplements to treat bowel diseases, build a strong immune system and sustain the immune system. At present, the action mechanism of Lactobacillus spp. towards RA remains unknown. Therefore, researchers conclude the latest analysis to effectively comprehend the ultimate pathogenicity of rheumatoid arthritis, as well as the functions of probiotics, specifically Lactobacillus casei or Lactobacillus acidophilus, in the treatment of RA in therapeutic and diagnostic reports. RA is a chronic inflammation immunological illness wherein the gut microbiota is affected. Probiotics are organisms that can regulate gut microbiota, which may assist to relieve RA manifestations. Over the last two decades, there has been a surge in the use of probiotics. However, just a few research have considered the effect of probiotic administration on the treatment and prevention of arthritis. Randomized regulated experimental trials have shown that particular probiotics supplement has anti-inflammatory benefits, helps people with RA enhance daily activities and alleviates symptoms. As a result, utilizing probiotic microorganisms as therapeutics could be a potential possibility for arthritis treatment. This review highlights the known data on the therapeutic and preventative effects of probiotics in RA, as well as their interactions.

Targeting Probiotics in Rheumatoid Arthritis.

In high dimensional data analysis (such as gene expression, spatial epidemiology, or brain imaging studies), we often test thousands or more hypotheses simultaneously. As the number of tests increases, the chance of observing some statistically significant tests is very high even when all null hypotheses are true. Consequently, we could reach incorrect conclusions regarding the hypotheses. Researchers frequently use multiplicity adjustment methods to control type I error rates-primarily the family-wise error rate (FWER) or the false discovery rate (FDR)-while still desiring high statistical power. In practice, such studies may have dependent test statistics (or p-values) as tests can be dependent on each other. However, some commonly-used multiplicity adjustment methods assume independent tests. We perform a simulation study comparing several of the most common adjustment methods involved in multiple hypothesis testing, under varying degrees of block-correlation positive dependence among tests.

A comparison of multiple testing adjustment methods with block-correlation positively-dependent tests

The relationship among the gut microbiome, global fecal metabolites and rheumatoid arthritis (RA) has not been systematically evaluated. In this study, we performed 16S rDNA sequencing and liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based nontargeted metabolomic profiling on feces of 26 untreated RA patients and 26 healthy controls. Twenty-six genera and forty-one MS2-identified metabolites were significantly altered in the RA patients. Klebsiella, Escherichia, Eisenbergiella and Flavobacterium were more abundant in the RA patients, while Fusicatenibacter, Megamonas and Enterococcus were more abundant in the healthy controls. Function prediction analysis demonstrated that the biosynthesis pathways of amino acids, such as L-arginine and aromatic amino acids, were depleted in the RA group. In the metabolome results, fecal metabolites including glycerophospholipids (PC(18:3(9Z,12Z,15Z)/16:1(9Z)), lysoPE 19:1, lysoPE 18:0, lysoPC(18:0/0:0)), sphingolipids (Cer(d18:0/16:0), Cer(d18:0/12:0), Cer(d18:0/14:0)), kynurenic acid, xanthurenic acid and 3-hydroxyanthranilic acid were remarkably altered between the RA patients and healthy controls. Dysregulation of pathways, such as tryptophan metabolism, alpha-linolenic acid metabolism and glycerophospholipid metabolism, may contribute to the development of RA. Additionally, we revealed that the gut microbiome and metabolites were interrelated in the RA patients, while Escherichia was the core genus. By depicting the overall landscape of the intestinal microbiome and metabolome in RA patients, our study could provide possible novel research directions regarding RA pathogenesis and targeted therapy.

/pdf/the-gut-microbiome-and-metabolites-are-altered-and-2kpfe34f.pdf

The Gut Microbiome and Metabolites Are Altered and Interrelated in Patients With Rheumatoid Arthritis

Helicobacter pylori (H. pylori) is strongly associated with a wide spectrum of gastrointestinal diseases, such as duodenal or gastric ulcers and gastric cancer. Currently, the main treatment of H.pylori infection involves the use of a combination of antimicrobial agents such as amoxicillin, metronidazole and clarithromycin and proton pump inhibitors (PPIs). In many guidelines, triple therapy consisting of two antibiotics (amoxicillin/metronidazole and clarithromycin) and a PPI is used as the first treatment line. Unfortunately, the increased resistance of H. pylori to clarithromycin and metronidazole adversely affect the effectiveness of triple therapy and reduces the eradication rates to an unacceptable levels. Several regimens has been proposed to replace standard triple therapy such as bismuth-containing quadruple therapy, sequential therapy, concomitant therapy, hybrid therapy and levofloxacin based therapy. Many regimens are used as rescue therapy based on what was previously used in the treatment such as bismuth quadruple therapy, rifabutin triple therapy and levofloxacin based therapies. However, due to the bacterial resistance to antibiotics that can limit the applicability of such regimens and because the resistance to amoxicillin is very low, high-dose dual therapy consisting of amoxicillin and a PPI has been proposed as an effective and safe first-line or rescue therapy.

https://zjps.journals.ekb.eg/article_126621_47a3ae7860a224c67f90d243dee3ab1f.pdf

Review: Treatment of Helicobacter pylori infection

Dysbiosis of oral microbiota is associated with systemic lupus erythematosus.

Background Recently, researchers have proposed a possible relationship between RA and the microbiome of the oral cavity and gut. However, this relation has not been systematically established. Herein, we conducted a comprehensive review of the pertinent literature to describe this possible association. Methods We systematically performed searches in databases, namely EMBASE, the Cochrane Library, and PubMed, from inception to 7 June 2020 to identify case-control studies that compared the oral and gut microbiome in adult RA patients with those of controls. The primary outcome was specific bacterial changes between RA and controls. The secondary outcome was microbial diversity changes between RA and controls. Results In total, 26 articles were considered eligible for inclusion and reported some differences. Therein, ≥3 articles reported decreased Faecalibacterium in the gut of early-RA (ERA)/RA patients compared with healthy controls (HCs). Also, ≥3 articles reported decreased Streptococcus and Haemophilus and increased Prevotella in the oral cavity of ERA/RA patients compared with HCs. In addition, some Prevotella species, including P. histicola and P. oulorum, showed increased trends in RA patients' oral cavity, compared with HCs. The α-diversity of the microbiome was either increased or not changed in the oral cavity of RA patients, but it was more commonly either decreased or not changed in the gut of RA patients. Conclusions In this systematic review, we identified the microbiome associated with RA patients in comparison with controls. More research is needed in the future to find the deep relationship between RA and the microbiome.

The oral and gut microbiome in rheumatoid arthritis patients: a systematic review

Objective 
At present, current didactic teaching delivery method help nursing students apply theory to clinical situations in an inefficient way. The flipped classroom (FC), a novel teaching mode emphasizing self-study and critical thinking, has generated interest in nursing education in China. However, there are a gap in the literature and no consistent outcomes of current studies which compared FC and lecture-based learning (LBL), and no systematic review has comprehensively compared theoretical scores as an affected outcome in FC versus LBL modes.


Methods 
In this review, we analyze flipped-learning nursing students’ scores, and aim to assess the efficacy and provide a deeper understanding of the FC in nursing education. Following the inclusion criteria, articles were obtained by searching PubMed, Embase and Chinese data, including the China National Knowledge Infrastructure, Wanfang Data, and VIP database until 3 January 2020. Data were extracted from eligible articles and quality was assessed. A meta-analysis was then performed using a random effects model with a standardized mean value (SMD) and a 95% confidence interval (CI).32 studies were included after reviewing 2,439 citations. All studies were randomized controlled trials (RCTs). The FC theoretical knowledge scores in FC were significantly positively affected compared to those of the traditional classroom (SMD = 1.33, 95% CI: 1.02–1.64; P < 0.001). In addition, 23 studies reported skill scores, indicating significant difference between the FC mode and LBL mode (SMD = 1.58, 95%CI: 1.23–1.93; P < 0.001).


Conclusions 
The results of this meta-analysis suggest that compared to the LBL teaching method, the FC mode dose significantly improve Chinese nursing students’ theoretical scores. However, the problems of heterogeneity and publication bias in this study need to be remedied high-quality future studies.

/pdf/flipped-classroom-improves-nursing-students-theoretical-3hteity9w3.pdf

Flipped classroom improves nursing students' theoretical learning in China: A meta-analysis.

The coronavirus disease 2019 (COVID-19) outbroke in Wuhan, Hubei Province, China, affecting more than 200 countries and regions. This study aimed to predict the development of the epidemic with specific interventional policies applied in China and evaluate their effectiveness. COVID-19 data of Hubei Province and the next five most affected provinces were collected from daily case reports of COVID-19 on the Health Committee official website of these provinces. The number of current cases, defined as the number of confirmed cases minus the number of cured cases and those who have died, were examined in this study. A modified susceptible-exposed-infectious-removed (SEIR) model was used to assess the effects of interventional policies on the epidemic. In this study, 28 January was day 0 of the model. The results of the modified SEIR model showed that the number of current cases in Hubei and Zhejiang provinces tended to be stabilized after 70 days and after 60 days in the four other provinces. The predicted number of current cases without policy intervention was shown to far exceed that with policy intervention. The estimated number of COVID-19 cases in Hubei Province with policy intervention was predicted to peak at 51 222, whereas that without policy intervention was predicted to reach 157 721. Based on the results of the model, strong interventional policies were found to be vital components of epidemic control. Applying such policies is likely to shorten the duration of the epidemic and reduce the number of new cases.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/jmv.25934

Strong policies control the spread of COVID-19 in China.

Efficacy and safety of bismuth-containing quadruple treatment and concomitant treatment for first-line Helicobacter pylori eradication: A systematic review and meta-analysis.

Xiu-Jie Chu

Papers

Dysbiosis of oral microbiota is associated with systemic lupus erythematosus.

The oral and gut microbiome in rheumatoid arthritis patients: a systematic review

Flipped classroom improves nursing students' theoretical learning in China: A meta-analysis.

Strong policies control the spread of COVID-19 in China.

Efficacy and safety of bismuth-containing quadruple treatment and concomitant treatment for first-line Helicobacter pylori eradication: A systematic review and meta-analysis.